Commentary From the Committee on Pediatric Education
The Committee on Pediatric Education (COPE) was formed decades ago as a gathering place for organizations with an educational focus to discuss their various missions, responsibilities, and commonalities. Over the years, COPE has become a think tank for discussion, consensus building, and collaboration with respect to emerging issues facing pediatric medical education. The committee consists of American Academy of Pediatrics (AAP) Board-approved Fellows of the AAP and representatives from pediatric professional and educational organizations who report to COPE regularly and contribute to activities throughout the year. The committee reviews and monitors the field of pediatric education, identifying gaps or areas in need of enhancement, and develops strategies and recommendations as needed.
The articles were chosen by the members of COPE to reflect the key issues in medical education that rose to prominence in each of the 3 quarter centuries and the ongoing struggles that all educational-related organizations experience in meeting the challenges of an ever-changing educational climate.
Era 1: 1948–October 1973
The Early Shaping of Medical Education
Hilary M. Haftel, MD, MHPE, FAAP1
Affiliation: 1Senior Vice President, Education, American Academy of Pediatrics
Highlighted Articles From Pediatrics
- Mitchell JM. Remodeling medical education. Pediatrics 1950;6(5):687-695
- Harvey SC. The objectives of medical education: an introduction to the consideration of a curriculum. Pediatrics. 1958;22(1):193-204
This era represented a time when the quality and characteristics of medical schools were under significant scrutiny. Medical schools exhibited great variability with respect to the demographics of their students and the content of their curricula. Several medical education authorities called for an overhaul of the medical school structure, admission practices, and teaching methodologies and shared their thoughts with the pediatrician audience through the journal Pediatrics. We consider these 2 articles to have been seminal in that they heralded new approaches to medical education, some of which were not widely implemented until decades later, including professionalism, new teaching methodologies, and an emphasis on diversity.
These articles pointed out that there were many qualities of exemplary physicians that were often innate to the people who would eventually enter the profession. These included integrity; intellectual ability; a “capacity for work,” which included both work-endurance and work-initiative; judgement; and skill in the use of the scientific method. It was also pointed out that these were not qualities that could be taught within the curriculum; these were by nature part of the makeup of the candidate themselves. This laid the foundation for what would ultimately be referred to as “professionalism” and openly documented the need to select applicants for admission to medical school who exemplified these innate qualities.
Also ahead of its time was the call for new teaching methodologies. In both papers, the authors advocated limiting didactic sessions in favor of more interactive learning techniques. They called for a focus on seminars and patient-focused sessions and provided a description of what we term today the “flipped classroom.” with the students providing the education with a facilitating teacher. They also pointed out that the patient needs to be understood within the context of their environment and consideration must be given to the effects of their illness on the entirety of their, and their families’, lives.
Importantly, these articles also spoke to the need for greater diversity. At the time, the candidates for any medical school were largely from the surrounding region, contributing little to geographic, gender, ethnic, or racial diversity. Dr. Harvey specifically stated that the student body should correlate with the diversity of the country. This is a challenge with which medical schools continue to struggle to this day.
These articles, shared in Pediatrics, laid the groundwork for modern day education and increased the awareness of pediatricians to the challenges of training physicians. Many of these suggestions were rapidly adopted, while others have encountered a more difficult path to implementation. What lies ahead for medical education remains to be determined, but the medical education leaders of the past have outlined the pathway forward.
Era 2: November 1973–October 1998
Community Pediatrics
Allen Friedland, MD, MACP, FAAP1
Affiliation: 1ChristianaCare, Sidney Kimmel Medical College at Thomas Jefferson University; Chair, AAP Committee on Pediatric Education
Highlighted Article From Pediatrics
- Roberts KB. Educational principles of community-based education. Pediatrics. 1996;98(6):1259-1263
According to the author, Dr. Ken Roberts, this article was borne from part of a presentation that he delivered at the national meeting on Pediatric Education in Community Settings when he was Pediatrics Program Director at University of Massachusetts. His program was 1 of 2 programs at the time that incorporated resident continuity clinics in community offices. (Dr. Tom DeWitt had oversight of the continuity component at University of Massachusetts.) This topic was identified to be presented at the urging of Dr. Errol Alden, who was executive director of the American Academy of Pediatrics at the time, due to its important nature, and Dr. DeWitt identified the author to prepare and present this topic at the meeting they both co-chaired.
This article laid out several themes about the desired approaches to resident education using community-based education as the example. These themes continue to resonate with those involved in undergraduate and graduate medical education in any specialty today.
Tradition has long fostered a teacher-centric model mostly built on didactic lectures (teaching) to residents instead of a more learner-centric model that could be built on experiences with specific objectives and outcomes (learning). Dr. Roberts believed the culture in medical education needed to change. He advocated that all graduate medical education, including community-based education, should incorporate adult learning theory elements summarized by Jane Vella to include “respect, building on previous experiences, immediacy of application, and opportunity to practice” in order to develop independent physicians.
Dr. Roberts also recognized that community faculty would require educational development because so many who welcomed residents in their offices had not received training in a learner-centered model during their residency training or in their practices.
Close to the time of this publication, the Ambulatory Pediatric Association was early to describe outcome-based goals for learners on each rotation instead of process measures in its published residency training educational guidelines. This was at the time the Residency Review Committee for pediatrics had initiated the requirement for residency programs to develop written goals and objectives for each rotation. By 2002, the Accreditation Council of Graduate Medical Education (ACGME) introduced to Graduate Medical Education the 6 “core competencies,” and by 2012, the “milestones.”
The author also created a mnemonic, GNOME, to help us all remember the 5 pivotal steps of planning education endeavors: Goals, Needs Assessment, Objectives, Methods, and Evaluation. A description of the common mistakes in the application of GNOME is included in this article.
Era 3: November 1998–Present
The Future of Pediatrics: Opinions From Within and Outside
Shabana Yusuf, MD, MEd, FAAP1
Affiliation: 1Member-at-large, AAP Committee on Pediatric Education. Baylor College of Medicine
Highlighted Articles From Pediatrics
- Johnson RL, Charney E, Cheng TL, et al. Final report of the FOPE II Education of the Pediatrician Workgroup. Pediatrics. 2000;106(suppl E1):1175-1198
- Jones MD, McGuinness GA, Carraccio CL. The residency Review and Redesign in Pediatrics (R3P) Project: roots and branches. Pediatrics. 2009;123(suppl 1) S8-S11
The article by Johnson et al focused on current and future directions of pediatric education. This was a grant-funded 3-year project and was similar to a previous comprehensive evaluation of pediatric education in 1978, which was termed Future of Pediatric Education, “FOPE I.” The recommendations of FOPE I were not incorporated in residency programs until 20 years later; however, recommendations from FOPE II were communicated to Federation of Pediatric Organizations (FOPO) for implementation.
The FOPE II Education of the Pediatrician Workgroup provided an assessment on the current and future state of pediatric education at different levels of learners, namely medical student, resident, fellows, and faculty. Future directions for medical student teaching included small group discussions in place of lectures, computer-assisted instructional programs with a focus on a simulated patient experience, problem-based learning, and clinical education in community-based settings. For graduate medical education, future trends included educational needs assessment and continuous improvement. It was noted that pediatric subspecialty training occurs in academic centers, and there is an inherent heterogeneity due to nature of training, although some fellowship programs shared research training with each other due to similarity in this domain. Future directions for subspecialty training called for oversight of such fellowship programs by departments of pediatrics accredited by the ACGME Residency Review Committee.
Finally, the role of continuing medical education (CME) as a life-long learning modality for physicians should take into consideration the delivery mode of such instruction, teaching effectiveness, teaching option preferences, self-directed learning, role of national professional organizations, and local pediatric academic departments. Although there are many avenues through which to provide CME, there is much overlap in what is available, yet coordination of CME delivery does not exist. So, in summary, this article comments on future direction in pediatric education for a pediatrician through various learning stages, which are all being implemented at the medical student, resident, fellow, and faculty level. Any future planning in pediatric education at different levels should take into consideration how child health needs intersect with the health care systems and with new advances in biomedical sciences. Programs should continuously self-evaluate whether the learning meets the requirements of accreditation bodies.
The article by Jones et al took a different approach to the evaluation of pediatric resident education. The ACGME evaluated medical education every 5 years. Instead of having members of pediatric education organizations as in Future of Pediatric Education (the FOPE I and II projects), the R3P project included the full breadth of pediatric primary care providers, including physicians, physician assistants, and nurse practitioners. However, the R3P committee had similar limitations as FOPE I and II in providing a one-time recommendation instead of ongoing evaluation of pediatric training by the pediatric community. The R3P project concluded that continuous evaluation, discovering innovative solutions and implementing strategies at program level through a decentralized process, would be more effective in improving pediatric resident education.
